Sri Lanka World Stroke Day

 Launching the Stroke Solidarity String on World Stroke Day 2012 at Temple Trees in Sri Lanka by presenting the string to His Excellency the President Mahinda Rajapaksha by the President of the National Stroke Association of Sri Lanka, Dr. Padma Gunaratne. Hon Maithripala Sirisena, Minister of Health and Dr. Harsha Gunasekara, Secretary of the stroke Association are also present.

Changes in spleen size

International Journal of Stroke Managing Editor spoke to Drs. Sean Savitz and Farhaan Vahidy on the eve of the online publication of this very novel study. You can download this interview here. 

https://itunes.apple.com/gb/podcast/changes-in-spleen-size-in/id580359468

The spleen in stroke patients undergoes dynamic changes of contractions and re-expansion in the days following the onset of stroke symptoms, releasing inflammatory cells and contributing to further brain injury, according to researchers at The University of Texas Health Science Center at Houston (UTHealth) Medical School.

“We’ve known from animal studies that the spleen contracts after stroke, followed by the release of inflammatory white blood cells leading to secondary brain injury, so we wanted to observe what happens to the spleen in patients after a stroke,” said Sean I. Savitz, principal investigator and professor of neurology at the UTHealth Medical School. 

Photo credit: NIH

“This is a completely understudied area. The spleen is not normally an organ that neurologists or neuroscientists pay attention to. This was our initial attempt to look at the size of the spleen in stroke patients.”

The spleen is part of the lymphatic system, which fights infection by releasing white blood cells. It also helps control the amount of blood in the body and destroys old and damaged cells.

The study included 29 stroke patients and 20 healthy volunteers. The research team performed daily abdominal ultrasounds to measure the size of the spleens. In the stroke patients, spleens initially reduced in size and then re-expanded. The spleens of the healthy volunteers showed minimal variation in daily spleen size compared with the stroke patients.

Savitz said the study demonstrated a good correlation between the contraction of the spleen and the amount of white blood cells in the body. The results also suggested that some patients whose spleens contracted for a longer period of time, releasing more inflammatory white blood cells, had poorer clinical outcomes. Further studies will be needed to confirm and explain these early findings, Savitz said.

Savitz and fellow researchers became interested in studying the spleen after animal studies at UT-Health and elsewhere showed that stem cells administered intravenously after a stroke travelled to the spleen, as well as to the brain.

“The big question was why,” said Savitz, who is director of the Stroke Program at UTHealth and an attending physician at Memorial Hermann-Texas Medical Center. “Emerging work by our group and other researchers suggest that some types of stem cells have a dampening effect on the inflammatory response emanating from the spleen. The spleen is a possible target in the future for treating stroke.”

Savitz’s research team at UTHealth included first authors Preeti Sahota, M.D., and Farhaan Vahidy, M.D. 

A little bit of art...

IJS are preparing to interview Swedish Neurologist Barbro B Johansson and I was touched by this image and historical note on her web page.
Her website 'banner' held this picture of a beautiful sculpture and I have left in tact the historical note she made about it as seen below.

Historical note: I took the picture of the sculpture on the top left when I visited the Institute of Neurosurgery and Brain Research in Santiago, Chile 1961. It is made by Marta Covin, a famous Chilean Sculptress (1905-1993), using the hands of Alfonso Asenjo as a model. Asenjo was a pioneer in neurosurgery that founded the Institute of Neurosurgery and Brain Research in Chile already in 1939. Because he was a friend of Salvador Allende the sculpture was removed and disappeared in connection with the military coop in Chile 1973. I think that the sculpture is a too beautiful illustration of what makes us human to be forgotten.

This re-empahsises for me as Managing Editor for the journal, the important work people do in neurology and how globally this work in undertaken in all conditions; how each individual treatment and care impacts on each human being which resonates globally. This gift of quality of life is why we at this journal, the flagship of the World Stroke Organization must always remember that we are a global platform for a global voice, so no matter the conditions that people work in, or the resources available to them, we are there to share knowledge and support these amazing practitioners to reduce the burden of stroke.

Trade-offs between effectiveness and efficiency in stroke rehabilitation

Trade-offs between effectiveness and efficiency in stroke rehabilitation

Keywords:

• activities of daily living;
• effectiveness;
• efficiency;
• rehabilitation;
• stroke;
• trade-off

Background Most stroke research has studied rehabilitation effectiveness and rehabilitation efficiency separately and not investigated the potential trade-offs between these two indices of rehabilitation.

Aims To determine whether there is a trade-off between independent factors of rehabilitation effectiveness and rehabilitation efficiency.

Methods Using a retrospective cohort study design, we studied all stroke patients (n=2810) from two sub-acute rehabilitation hospitals from 1996 to 2005, representing 87·5% of national bed-years during the same period.

Results Independent predictors of poorer rehabilitation effectiveness and log rehabilitation efficiency were • older age • race-ethnicity • caregiver availability • ischemic stroke • longer time to admission • dementia • admission Barthel Index score, and • length of stay.

Rehabilitation effectiveness was lower in females, and the gender differences were significantly lower in those aged ≤70 years (β −4·7 (95% confidence interval −7·4 to −2·0)). There were trade-offs between effectiveness and efficiency with respect to admission Barthel Index score and length of stay. An increase of 10 in admission Barthel Index score predicted an increase of 3·6% (95% confidence interval 3·2–4·0) in effectiveness but a decrease of 0·04 (95% confidence interval −0·05 to −0·02) in log efficiency (a reduction of efficiency by 1·0 per 30 days). An increase in log length of stay by 1 (length of stay of 2·7 days) predicted an increase of 8·0% (95% confidence interval 5·7–10·3) in effectiveness but a decrease of 0·82 (95% confidence interval −0·90 to −0·74) in log efficiency (equivalent to a reduction in efficiency by 2·3 per 30 days). For optimal rehabilitation effectiveness and rehabilitation efficiency, the admission Barthel Index score was 30–62 and length of stay was 37–41 days.

Conclusions

There are trade-offs between effectiveness and efficiency during inpatient sub-acute stroke rehabilitation with respect to admission functional status and length of stay.